||Childrens Medical Office
of North Andover, P.C.
This tends to be
a time when babies get their first colds and other illnesses, particularly during winter
months. Most are not dangerous at all. The best clue is in the eyes - a baby who looks
well usually is, while a baby who is really ill will tell you with the look in his eyes.
- Prevention is best. All babies should see the
pediatrician at about 4, 6, and 9 months of age. These visits are not just for shots, but
are times when we screen for a variety of subtle problems and are a good opportunity for
you to learn more about your baby.
- At 4 and 6 months the baby will receive vaccines again. Mild soreness at the site of the vaccines is likely. Giving
Acetaminophen every four hours for a day may prevent or minimize this. The benefits of
giving these vaccines FAR outweigh the risks involved. If you want to know more about
this, see our more detailed vaccine handouts or ask.
- Fever is the body's
normal response to any kind of illness and actually HELPS you get better. It is not
dangerous and cannot hurt your child. Furthermore, neither the presence nor the height of
a fever has any correlation with how dangerous the illness causing it is. Minor viruses
often cause very high fevers, while some deadly illnesses cause little fever at all. Thus,
it is the OTHER symptoms of illness we are most interested in when evaluating your child.
- Fever is uncomfortable, and this is why we treat it.
Use Acetaminophen (Tylenol, many other brands)
infant drops according to the instructions in our Acute Illness Guide. Never use aspirin
in children. Sponge baths are also unwise - they actually raise the temperature deep
inside the body rapidly while cooling only the surface. Getting the child with a fever to
drink plenty of fluids is important for many reasons, and will help get the fever down as
- Do not use nonprescription
"over-the-counter" medications for coughs,
colds, diarrhea, etc. unless directed
by a physician. In general, the side effects far outweigh the minimal benefits in this age
- Teething can start anytime from 3 - 15 months, and
is somewhat painful. It can cause drooling, a runny nose, poor sleep, irritability, and
even pulling at the ears. It does not cause fever, vomiting, diarrhea, or a rash however.
It is best to avoid "rub on" teething medications - babies can overdose on
these. Use Acetaminophen for the pain and give the baby something to chew on to speed up
the process. A bagel often works better than conventional teething rings, especially
beyond 6-7 months age.
- Even a minor illness that doesn't seem be getting
better after 7-10 days should be seen by the doctor.
Babies need FULL
- Continue to use your car seat at all times. Change from an infant car seat to a convertible car seat once manufacturer's weight & height limit have been met, however continue to keep the seat rear-facing until 2 years of age.
Remember, car accidents are the SINGLE BIGGEST THREAT to your babies health.
- Test baby's high chair before you buy it. The base
should be wide and stable so it will not fall over if bumped by another person or if the
baby tries to crawl out. NEVER leave the baby alone in a high chair.
- Don't put the baby in a walker. They lead to falls,
poisonings, and chokings. Swings, playpens, and "johnny jumpers" are all much
- Now is the time to "Childproof" your home. Be sure all small objects that the baby could choke on are both out of reach and out of
sight (e.g. buttons, coins, bottle caps, pins, nuts, raisins, older child's toys). Put
"shock stops" in all unused electrical outlets and move all cleaning fluids,
medicines, etc. to high cabinets. Don't rely on so-called "Childproof" cabinet
latches - they don't work. Make sure your water heater is set not to exceed 120ºF.
- Never turn your back on a baby in a bath, on a
changing table or on a bed EVEN FOR A SECOND!
- Introduce solids anytime between 4 and 6 months.
Usually your baby will tell you he is ready by watching you eat with intense interest and
by being somewhat less satisfied after a breast or bottle feeding.
- Start slowly - at first this is a new experience.
Your baby will need time to learn. When the baby starts to spit or push the spoon away -
stop, don't push it. There will be plenty of interest later.
- Initially feed your baby one solid meal per day.
Space it in between breast or bottle feedings so that you are not giving milk right after
or right before; that way the baby is not full, nor are you "rewarding" him or
her for stopping by giving milk at the end of the meal.
- Start with rice cereal mixed with formula,
breastmilk, or water. You can introduce a new food every 4-5 days, never more that one at
a time so that if one causes a problem you'll know which it was. Once the baby has tried
several different cereals, move on to white fruits (apples, bananas, pears) and after that
yellow vegetables (squash, sweet potatoes, carrots). Beyond that the "sky's the
limit" although it is a good idea to read ingredient labels and avoid things which
contain long lists of ingredients or lots of chemical additives.
- When the baby readily takes about 2 oz. at a meal,
he is ready for a second daily meal. When he takes 4 oz. (1 standard baby food jar) at each
meal, introduce a third. It doesn't matter which meal you start with, but feedings should
be at consistent times every day.
- Foods to avoid in the first year: Citrus
fruits/juices, eggs, fish, nuts, wheat. This is particularly important in families with
allergic histories, much less so in non-allergic families. Wheat can be hard to avoid - it
"hides" in "mixed" cereal, baby cookies and toasts, and many other
baked goods. Eggs are also commonly "hidden" ingredients you must be on the
- Continue using breastmilk or an
iron-fortified formula as the main drink throughout this age group. Both have many
distinct advantages over regular cow's milk that your baby still deserves the benefit of.
Also, avoid juice. Even "natural" juice is little more than sugar and water,
your baby needs it about as much as you need beer.
- It's a good idea to inspect bottles of baby food
before you buy them. Avoid ones that look "beat up", have peeling labels, dented
caps, etc. Indeed, you may want to avoid stores that stock bottles in that condition on
their shelves at all.
- Babies under one year of age should not consume honey
- Breast & Bottle-fed babies should be taking a liquid multi-vitamin (Poly-vi-sol with Iron).
Development & Stimulation:|
- By four months your baby is a very capable person!
He or she is vocalizing constantly, rolling over, reaching and grasping objects, and
clearly differentiating you from strangers. Everything goes in the mouth, as this is the
most discriminating sense organ at this age. Weight will soon be double what is was at
- Around 6 months your baby will sit without support
and pass objects from one hand to another. Soon consonant sounds such as ba-ba or ma-ma
will be added to vocalizations. Often the latter starts with tongue thrusting games such
as blowing bubbles or "raspberries". By 9 months your repeated expressions of
delight at hearing "ma-ma" or "da-da" will be starting to teach the
baby that words have meaning and that you are called by that name!
- By 9 months babies are also starting to become much
more mobile. They may crawl or creep (although many children skip this), or they may be
beginning to "cruise" - pulling themselves up on furniture and getting around by
hanging on. Appropriate toys for this age group include any brightly colored, noise-making
objects small enough to be grasped by little hands yet big enough not to present a choking
hazard. You want to expose the baby to a wide variety of shapes, colors, sounds, and
- Also by 9 months certain key signs of normal thinking abilities
should start to appear. The most importance of these are "joint
attention" and "object permanence". Joint
attention is when the baby actively "shares" his or
her attention to something fun or interesting with someone else - usually a
parent or sibling. They might point and laugh, and look back and forth
from the object to the other person to gauge the other
person's response. Object
permanence means that just because something is out of sight,
it's not gone. Children who have object permanence will understand
that a hidden object can be retrieved, and will start
to enjoy the game of "peek-a-boo".
Sleep: Don't fall into the trap!|
This is an important age for establishing normal sleep patterns. While holding or rocking
your child to sleep was fine for the first few months, you need to try hard to get away
from that now. Establish a bedtime "ritual" for when you are going to put the
baby down, and then be sure the baby falls asleep IN BED, not in your arms. There should
be no bottle involved. This way, the baby can learn to go to sleep independently, without
you or the bottle to help. When brief awakenings, which are normal, occur during the night
the baby will then not need you to "go back down". Both of you will sleep better
as a result. If some crying is necessary to get from where you are now to this state of
affairs you should endure it - it will not hurt your baby and will be well worth it in the
Bathing & Skin Care:|
Sunlight is the biggest threat to healthy
skin. ALWAYS use a sunscreen on exposed baby's skin - even in spring and fall when you
might not think of it. Select a PABA-free preparation with SPF 15 - 30.
Ointment is better than powder for
protecting against diaper rash, but it really doesn't matter which ointment you use.
Powders (all types) can also be dangerous if accidentally inhaled. Soap is very drying to
the skin, even "baby soap". Dove is the mildest and probably the best. Avoid
Yourself & Your Family:|
A baby needs happy, satisfied parents.
Are there things you enjoy but haven't done since
baby arrived? Get back to them now! Set aside time to be with your partner by getting a
babysitter. Spend some special time alone with the baby's older siblings. Maintain your
hobbies, interests, career, etc.
It is normal and very common for parents to feel
depressed, anxious, and overwhelmed. It may seem hard to cope with a screaming baby and
you may even feel as if you're about to lose control. Help is available. Call us or call:
Parental Stress Line # 1-800-632-8188
Other important telephone #'s to keep by your phone:
National Poison Control Hotline
Police/Fire/Ambulance - 911